Get Alaska Pioneer Home Waitlist Application. Alaska Pioneer Home Waitlist Application

Completing the Alaska Pioneer Home Waitlist Application is a vital step for individuals seeking residency in one of the Pioneer Homes across Alaska. This guide offers clear, step-by-step instructions to assist users in filling out the application accurately.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the Alaska Pioneer Home Waitlist Application form and open it for editing.
2. Fill in your full name as it appears on your birth record, along with your date of birth, social security number, and state or country of birth.
3. Indicate your U.S. citizenship status and whether you are a U.S. veteran by selecting 'Yes' or 'No'.
4. Provide details regarding your residency in Alaska, specifically how long you have lived in the state, and confirm if you have been a resident for at least one year prior to this application.
5. Complete the section regarding your Medicare coverage by indicating whether you have Medicare parts A, B, or D.
6. Select your waitlist preference by checking either the Active Waitlist or Inactive Waitlist box, depending on your readiness for admission.
7. If applying for the Active Waitlist, ensure you include additional documents such as proof of age, Certificate of Need, and a History & Physical exam.
8. If you selected the Inactive Waitlist, ensure to provide proof of age and state that you are not ready to enter a Pioneer Home.
9. Numerically rank your preferred Pioneer Home locations, if applicable, indicating only those you are willing to live in.
10. List two adult Alaska residents who can verify your residency. Include their name, address, relationship to you, and contact information.
11. Review the application information for accuracy and completeness before signing.
12. Sign and date the application, and have a witness sign if necessary. Attach any required documents and submit the form.
13. Finally, save your changes, and prepare to download, print, or share the completed form as necessary.

Complete your Alaska Pioneer Home Waitlist Application online today to secure your place.